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Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms

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Abstract

Background and Purpose

Cangrelor is a P2Y12 inhibitor that presents the advantage of having a short half-life. Its use may be helpful in the management of antiplatelet therapy for patients with intracranial aneurysms treated by stent-assisted coiling or flow-diverter stents. The purpose of this study was to report early experiences in using cangrelor for such indications.

Material and Methods

From October 2017 to November 2018, 7 consecutive patients (5 females, 2 males, mean age = 56 years) were managed with cangrelor as antiplatelet therapy, combined with aspirin, for stent-assisted coiling embolization and flow-diverter embolization of challenging intracranial aneurysms. Anti-aggregation protocols, including cangrelor, were systematically recorded. Treatment-related complications (minor/major hemorrhagic complications, ischemic complications) as well as clinical and angiographic outcomes (evaluated at 8.7 ± 4.2 and 8.75 ± 10 months, respectively) were retrospectively analyzed.

Results

Of the aneurysms 71.4% (5 out of 7) were ruptured and treated in the acute phase. In one case cangrelor was used as an alternative to clopidogrel in an asymptomatic hemorrhagic complication after stent-assisted coiling for better control of a possible worsening of the intracranial bleeding. Of the patients, 1 (14%) with a complex ruptured MCA aneurysm treated with a flow-diverter stent experienced a severe intracranial hemorrhage, which occurred after switching the cangrelor to ticagrelor and eventually led to death. No hemorrhagic complications under cangrelor were recorded for the six remaining patients. No mRS worsening was observed at discharge, except for the patient who died and six out of the seven patients had a mRS ≤2 at follow-up.

Conclusion

Cangrelor is a new antiplatelet therapy with a P2Y12 inhibiting effect, with a rapid onset and offset of action, owing to its short half-life. This cases series presents a pilot experience with promising results in terms of antiplatelet management for challenging intracranial aneurysms treated by stent assisted coiling or flow-diverter stents.

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Abbreviations

ACA:

Anterior cerebral artery

DSA:

Digital subtraction angiography

FDS:

Flow diverter stent

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

PCI:

Percutaneous coronary intervention

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Author information

Authors and Affiliations

  1. Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France

    Lamine Abdennour, Mehdi Drir, Jugurtha Mathout, Remy Bernard & Vincent Degos

  2. Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l’Hôpital, 75013, Paris, France

    Nader Sourour, Kévin Premat, Eimad Shotar, Stéphanie Lenck & Frédéric Clarençon

  3. Sorbonne University, Paris, France

    Kévin Premat, Alexandre Carpentier, Vincent Degos & Frédéric Clarençon

  4. Neuro-Intensive Care Unit, Fondation A. de Rothschild, Paris, France

    Guillaume Taylor

  5. Department of Anesthesiology, Hôpital Européen Georges Pompidou, INSERM UMRS-1140, université Paris Descartes, Paris, France

    Anne Godier

  6. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France

    Alexandre Carpentier

Authors
  1. Lamine Abdennour
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  2. Nader Sourour
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  3. Mehdi Drir
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  8. Jugurtha Mathout
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  12. Vincent Degos
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  13. Frédéric Clarençon
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Corresponding author

Correspondence to Frédéric Clarençon.

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Conflict of interest

L. Abdennour, M. Drir, K. Premat, E. Shotar, G. Taylor, A. Godier, J. Mathout, S. Lenck, R. Bernard, A. Carpentier and V. Degos declare that they have no competing interests. F. Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion (payment for readings), Codman Neurovascular (core lab). N. Sourour is consultant for Medtronic, Balt Extrusion, Microvention, Stock/Stock Options: Medina. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical standards

Patient families were informed before each treatment of the strategy that was chosen and gave verbal consent. The need for patient informed consent for retrospective analyses of records and imaging data was waived by the IRB. This work conforms to the World Medical Association Declaration of Helsinki.

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Abdennour, L., Sourour, N., Drir, M. et al. Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms. Clin Neuroradiol 30, 453–461 (2020). https://doi.org/10.1007/s00062-019-00811-2

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  • DOI: https://doi.org/10.1007/s00062-019-00811-2

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